These are the real consequences of a colossal political lurch, in this case by the United Kingdom, which, almost three years ago, suffocated by the pandemic and the ravages of a devastating Brexit, decided to cut its development aid and eliminate a program that allowed the poorest of the poor receive treatment in 23 African and two South Asian countries.
The consequences are still strongly felt on the ground.
It is the story of how decisions made in contexts of political pressure and electoral calculations irreversibly determine the lives of people thousands of kilometers away.
One of these people is David, a Liberian boy with a leg that started swelling about a year ago.
Many of his neighbors think that it is some type of witchcraft but in reality, it is due to a parasite transmitted by mosquitoes;
worms that lodge in the lymphatic vessels and spread throughout the body through the blood.
The ailment is called lymphatic filariasis, popularly known as elephantiasis, one of the so-called neglected tropical diseases (NTDs).
The world was moving at a good pace towards their elimination, but now there is a setback – fueled not by science, but by politics – and they may once again pose a threat to public health.
Abraham Kallie, 45, is a health volunteer in his community, in Phoebe, in Bong County (northern Liberia).
With a 1.8 meter colored stick, he calculates the dose of medicine that each child must receive to prevent parasitic diseases.anesvad
Phebe Hospital, Bong County.
It is the largest health center in the area, but many of the community's inhabitants have never set foot in it.
Although the lack of money to travel has an influence, so does the lack of knowledge of the diseases that afflict them, their causes and their remedies.anesvad
David Sumo is 18 years old.
One year ago his leg started to swell.
He has never seen a doctor.
He suffers from lymphatic filariasis, a mosquito-borne disease, commonly known as elephantiasis.anesvad
Nowai Kerkula rides a motorcycle through communities in Bong County to report on neglected diseases.
It is one of the 15 counties of Liberia, a country of 5.2 million inhabitants and an annual per capita income of $735, 12th lowest in the world.anesvad
Mercy Pewee, who suffers from lymphatic filiariasis, and Nowai Kerkula, a worker at the Liberian Ministry of Health.
Kerula travels through the communities of Bong County to care for patients with neglected diseases and to raise awareness among residents of prevention measures.anesvad
Karsor Kollie is responsible for the neglected diseases program at the Liberian Ministry of Health.
They have been trying to eradicate them since 2012, with the massive distribution of medicines, and they hope to have eliminated four of them by 2030.anesvad
Some of the volunteers in the mass distribution program of medicines against neglected diseases in Liberia receive instructions to implement the plan.
They will have to go to the communities to explain the importance of taking medications that can prevent onchocerciasis, lymphatic filariasis, schistosomiasis and helminthiasis, all diseases caused by parasites or contaminated water.anesvad
Despite the size of his left leg, which prevents him from walking normally, and his oozing sores, David has never seen a doctor.
From his house, in the heart of Liberia, to the nearest hospital, there are 12 kilometers, which can be traveled by motorcycle in half an hour along the dirt road that separates him from Phoebe, in Bong county, one of the 15 that They make up this country of 5.1 million inhabitants.
But his mother never wanted to take him.
In a laconic conversation, David, 18, doesn't quite know how to explain why.
He mentions the money to get there—Liberia has an annual
per capita
income of $735, making it 12th from the bottom in the world—but in most of these cases distrust in medicine and ignorance about medicine plays a role. the causes and cures of the disease.
The WHO estimates that around 36 million people are infected by this parasite worldwide, although only a small proportion develop symptoms.
The most extreme, like David's, lead to frightening deformities in the extremities.
In Liberia, those who live with this disease—those who have least known someone who suffers from it—tend to call it “
big foot
.”
Once the leg has acquired that state, it no longer has a remedy.
With cleaning and treatment he can improve his quality of life, but David will no longer be able to play football or join the army, which is what he would like to do to earn a living as an alternative to subsistence farming, the main occupation in all its surroundings.
Caught in time, the disease could have been stopped.
And with preventive treatment, he never would have contracted it.
In total, there are twenty preventable diseases, some also curable, but without adequate treatment they destroy the bodies and lives of millions of people.
They are also diseases of the poor, because they mainly affect countries in the global South and disproportionately affect women and children, which is why they do not receive sufficient attention or funds from developed societies or, often, from their own governments. , and which are caused by parasites transmitted by various insects or contaminated water.
Two years ago, suffocated by the pandemic and the ravages of Brexit, the United Kingdom decided to cut its development aid, from 0.7% of GDP to 0.5%, and eliminate the 220 million pounds per year that allowed the most poor of the poor receive treatment in 23 African and two South Asian countries
Chemical prophylaxis, which consists of the preventive taking of medications on a massive scale in affected areas, is the WHO's main strategy to eradicate this and other NTDs.
It is an achievable goal and the medication is available to governments free of cost.
But it is necessary to reach the entire population at risk and maintain consistency.
In 2014, the Ebola crisis that the country suffered paralyzed the program.
In 2020 it was covid.
Every lost year is an opportunity for diseases to get some oxygen and advance positions.
In 2021 the final blow came with the withdrawal of British funds.
The United Kingdom was the main support for the project to eliminate NTDs, from which millions of patients suffer in dozens of African countries.
Two years ago, suffocated by the pandemic and the ravages of a devastating Brexit, the United Kingdom decided to cut its development aid, which went from 0.7% of GDP to 0.5%, and eliminate the flagship program in research and NTD treatment.
Thus, the 220 million pounds per year that allowed treatment in twenty countries in Africa and two in Asia disappeared.
Go back what has been advanced
“The gap left by the British Government was so big that it has been very difficult to fill.
We have not recovered the level of funding for NTDs.
After the British cut, there are more orphan countries,” says Jorge Cano Ortega from the Republic of Congo, in charge of evaluating the impact of the cessation of financing at the World Health Organization (WHO).
“We have spent many years investing in the control of these diseases and with a little more effort they could be eliminated.
The risk is losing all the gains achieved.”
There are diseases, he explains, in which the interruption of a year or two of treatment means returning to the original scenario.
There are countries that have been on treatment for 20 years and can lose what they have gained.
Cano maintains that the British case is especially significant, but not unique.
“It is a trend that we have seen with other funders because since Covid, malaria has also suffered, and NTDs have lost interest.”
Many years have been invested in the control of these diseases and with a little more effort they could be eliminated.
The risk is losing all the profits achieved
Jorge Cano Ortega, in charge of evaluating the impact of the cessation of funding at the WHO
In response to a request from this newspaper, the WHO has prepared an analysis that indicates that the cut in funds is considered “a major setback for the control of NTDs in sub-Saharan Africa” and explains, for example, that in the case of lymphatic filariasis, the number of patients who stopped receiving treatment increased from 31% to 67% between 2020 and 2021. The following year there was an improvement, but the WHO recalls that stopping treatment increases costs and increases the risk of infection.
In Nigeria, for example, almost 60 million people stopped receiving treatment in 2021. By 2024, there is again a considerable lack of financing.
Some programs have recovered with patches and one-time donors, but in general, coverage for these diseases has fallen compared to pre-pandemic levels, according to the WHO's internal analysis.
The countries affected by the British cut embarked on a desperate race to find financing to cover the gap.
Some found it and some didn't.
In the case of Liberia, the British decision keeps the health authorities of the African country in suspense, which seeks funds for the program each season.
Until last year they had the help of the Canadian NGO Effect Hope and the Liverpool School of Tropical Medicine, but this institution completed an investigation last year and withdrew.
Karsor Kollie, head of Liberia's NTD program, says that since 2021 they have been looking for financiers who would allow the disease elimination plan to continue last year.
They found one
in extremis
last summer in Spain.
Participating in this program was not something that was on the road map of the Spanish organization Anesvad, but the Liberian authorities convinced them of the urgency of financing.
Larraitz Ventoso, project technician at the foundation, summarizes it: “Normally we focus on case management [treating diseases] because it was something for which there was less funding.
But when they explained to us the withdrawal of funds from various international partners, we saw that it was necessary to get involved with prevention to prevent the system from overflowing, something we had never done until now.
It is a task in which large international development investors usually participate.”
London championed the fight against NTDs.
Three months before the budget blow, Boris Johnson announced that the Government had provided treatment to 160 million people in Africa and Asia and that it remained committed to eradicating these diseases
Until the British cutback, London had led the fight against NTDs.
In fact, in January 2021, the then Prime Minister of the United Kingdom, Boris Johnson, issued a video message to commemorate the day of forgotten diseases in which he said: “Children are going blind, many are losing their teeth. , there are people who are disfigured or even die from diseases that are often easy to treat and prevent […] there is nothing inevitable about this suffering.”
He also explained that the number of people at risk of contracting this disease had decreased by 600 million.
That the Government had provided treatment to 160 million people in Africa and Asia, and remained committed to eradicating these diseases.
Three months later the budget blow arrived.
The United Kingdom, along with the United States, was the main donor for this type of disease.
Germany, France and Japan followed at a distance.
After the British scare, philanthropy came to the rescue to try to cover the gap in part of the affected countries.
“Evidently they never covered it 100%,” explains Cano.
The expert estimates that 141 million people are not receiving treatment for these diseases in 27 African countries that need it.
The almost 900,000 euros contributed this year by the Anesvad Foundation – which has also covered the expenses for this report – have allowed prophylaxis to begin this past November.
That figure covers almost 65% of the program and is added to the 35% that Effect Hope maintains.
One of the premises for Anesvad was to create a medium-term strategy.
It will last four years and will involve an advocacy plan so that the project is not abandoned and a large donor can add to the financing, or take charge of it.
A logistical labyrinth
What is critical about this type of project is not the medications themselves, mainly three very well-known and safe ones (ivermectin, albendazole and praziquantel).
The country (and others in the area) has access to these drugs thanks to donations from the WHO and pharmaceutical companies.
The really complicated thing is distributing them, something that, in addition to the logistics of reaching very remote and poorly communicated areas, includes training volunteers who have to explain to their communities why it is important to take these pills.
And, often, convince them that ailments do not arise from witchcraft or the evil eye.
Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs, the international alliance to combat these diseases, based in the United Kingdom, explains that the NTD case is an extraordinary case, because through London declaration in 2012, a group of pharmaceutical companies from G-7 countries committed to providing millions of treatments... and they fulfilled it.
The States needed to receive the medicines, map the territory to determine who needed them, and supply them.
“Imagine what it means for a woman who has a child with an intestine infested with worms to know that there is a treatment for him, but that they cannot get it to him.
“We are deepening inequalities when in reality we have the solution in our hands.”
Imagine what it means for a woman who has a child with an intestine infested with worms to know that there is a treatment for him, but that they cannot get it to him.
We are deepening inequalities when in reality we have the solution in our hands
Thoko Elphick-Pooley, executive director of the international alliance to combat neglected tropical diseases
Elphick-Pooley says that there were cases after the funding cut in which they even had to transfer consignments of medicines that had already been delivered from one country to another that had the capacity to distribute them.
“There is a lot of talk about public-private partnerships, but in this case it is the governments that are not complying.”
In the case of the British Government, its cuts were said to be a temporary measure, but the program has not been reinstated nor have the levels of aid then reached.
“Even if they wanted to, politically they feel that they cannot go back on their words, because it would be equivalent to having made a mistake,” says Elphick-Pooley.
Furthermore, when a country like the United Kingdom abandons a large program, it somehow sends the signal that this is not a priority, and it is difficult to convince other donors that such investments are profitable.
But these diseases are “one of those rare cases in which donors can show citizens that their tax dollars have been worth it,” Elphick-Pooley believes.
There are 50 countries that have already eliminated at least one NTD.
A spokesperson for the British Ministry of Foreign Affairs, Commonwealth and Development assures this newspaper that "the United Kingdom is committed to the fight against malaria and will continue to be one of the main donors with the aim of ending malaria by 2030."
Regarding the fight against NTDs, they attribute the suppression of funds to the impact of the pandemic and assure that after the cut they supported the completion of operations and other scheduled activities to the extent possible.
The result of having interrupted some programs is that there will be countries that will take much longer to eliminate these diseases, with the consequent human cost.
“In others, they will become bigger problems because in infectious diseases you cannot avoid intervening.
There are diseases that have pandemic potential, as we are seeing with dengue that is growing in Europe.
They are a risk to public health,” says Elphick-Pooley.
In fact, the Malaria and NTD Summit held last year in Kigali concluded that “with the disruption of essential services and supply chains during the Covid pandemic and the stagnation of funding, the rapid increase in population and widespread biological challenges, such as resistance to insecticides and drugs, work to eliminate these diseases has stalled and even gone backwards in some countries.”
Let them take the pills
Back in Liberia, in Phoebe, at the end of November, Kollie speaks to a group of about twenty people.
They are leaders of the surrounding communities, of young people, of women.
Influential people who can persuade their people that, when the volunteers arrive on motorcycles with the pills, they take them.
“The reason why their skin doesn't itch, why they don't go blind or have
big feet
is because they take the medication every year,” the ETD person in charge tells them.
He does not know how many cases the country reports each year, whose epidemiological resources are more than limited.
But he does affirm that there are fewer and fewer of them thanks to the prophylactic administration of drugs, which manage to eliminate the parasites in the bodies of those infected, whether or not they have symptoms.
And this not only benefits them, but cuts transmission to other people.
The worms are cornered until they no longer have a host and disappear, making it unnecessary to continue prophylaxis.
The result of having interrupted some programs is that there will be countries that will take much longer to eradicate these diseases, with the consequent human cost
In the talk with community leaders, they mix these messages with others about basic hygiene, such as not urinating or defecating in the waters where the surrounding populations clean themselves, wash their utensils or children bathe to cool off and play in a tropical country full of of vegetation, rivers and streams.
“No matter how much we warn them about the risks of these waters, it is impossible for them not to use them, because they have nothing else, so the only way to end diseases is with the mass administration of medications,” explains Peter S. Kollie. , NTD reference of the Ministry of Health in Bong County.
Abraham Kallie, 45, is one of the volunteers attending the talk.
He has a 1.8 meter wooden rod divided into colors: it is used to measure the children and give them the dose of medicine depending on the color they reach.
He lives in the Raymond Town community, of 166 people, among whom is also David, the boy with filariasis.
Kallie is a farmer, has seven children, and enthusiastically recounts his involvement in the fight against neglected diseases: “I tell [the neighbors] that medicine is good for them.
It's like a bulletproof vest.
If they shoot you it doesn't do anything to you.
And I tell you that if they get infected they can get very sick.
But despite that, some do not listen to me, they believe that it is the medicine that makes them sick.”
What Abraham Kallie tells is a classic of preventive medicine.
In the country it is increasingly rare to see cases like David's, or onchocerciasis, which manifests itself with itching all over the skin and can lead to blindness;
or schistosomiasis, which can cause abdominal pain, diarrhea and blood in the stool, as well as an increase in the size of the liver in advanced cases.
It is not as intuitive to identify the benefits of a medication that has prevented a disease as that of another that cures it.
And you don't have to go to remote African communities to see it, as has been seen in the West with Covid vaccines among small, but noisy population groups.
The fact that diseases are becoming less frequent, paradoxically, does not help elimination.
The population is losing fear.
They are more aware of others, such as malaria, which is daily in these areas.
And, when they do appear, NTDs are fraught with stigma.
By not knowing the causes of diseases, populations also tend to ignore how they are transmitted.
“Families must be brought together to tell them that with medication they stop being contagious.
It is very important to prevent the mental problems that are usually associated with NTDs,” says Peter S. Kollie.
Emerson J. Rogers, who coordinates case management in Liberia, says that the impact of these diseases not only has to do with physical health, but often prevents those affected from earning a living and supporting their family.
“We have cases of patients who have been abandoned by their loved ones, husbands who have left their wives due to lymphedema [swelling in the legs], or women who have left their husbands due to a buruli ulcer [a disease caused by a bacteria from the family of those that cause leprosy and tuberculosis], which can be cured with some time [it usually subsides with antibiotics].
We have seen people who have never been cared for before attempt suicide.
But we went to their communities or saw them in health centers and that simply gave them relief, they saw that someone cared about them,” he says.
David has never received medical care, but he is lucky with his environment.
“My friends in the community support me and help me,” he says, surrounded by other kids his age who show him their love.
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